Superior Dental Care - Dental Network Specialist

Note: This is a hybrid position based in Centerville, OH, requiring 5 days onsite for initial training, transitioning to a 3-day onsite schedule thereafter.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Superior Dental Care - Dental Network Specialist

Job Summary:

To support the development and enhancement of the company's dental network, this position handles provider applications, assists with the credentialing process, assists with recruitment campaigns, and manages ongoing relationships with both individual providers and Dental Service Organizations (DSOs) providers, guided by knowledge of corporate acceptance, participation, and professional review procedures.

Responsibilities:

• Works with Senior Dental Network Specialist(s) to support credentialing and the ongoing relationship management of both individual and Dental Service Organizations (DSO) providers.
• Utilizes various system platforms to maintain up-to-date provider and Dental Service Organization (DSO) records and financial information. Processes provider claim pends and manages internal and external provider inquiries and submissions (such as those related to recruiting campaigns, contracting, and fee schedules) in a timely manner through multiple communication channels.
• Assists with technical support, provider registration, secure provider portal access and provider file monitoring.
• In support of Medicare Advantage compliance, works with Senior Dental Network Specialist(s) to facilitate processing updates for excluded and precluded providers based on the Center for Medicare and Medicaid requirements.
• Assists Senior Dental Network Specialist(s) to ensure seamless support and effective teamwork.
• Performs other duties as assigned.

Superior Dental Care - Senior Dental Network Specialist

To support the development and enhancement of the company's dental network, this position independently handles provider applications, completes the credentialing process, participates in recruitment campaigns, and manages ongoing relationships with both individual providers and Dental Service Organizations (DSOs) providers, guided by knowledge of corporate acceptance, participation, and professional review procedures.

Responsibilities:

• Responsible for credentialling and ongoing relationship management of both individual and Dental Service Organizations (DSO) providers. This involves making decisions regarding applications for network participation and working with a credentialing committee to report, assess, and present more complex cases.
• Utilizes various system platforms to maintain up-to-date provider and Dental Service Organization (DSO) records and financial information. Processes provider claim pends and manages internal and external provider inquiries and submissions (such as those related to recruiting campaigns, contracting and fee schedules) in a timely manner through multiple communication channels.
• Offers technical support and manages provider registration and secure access to the provider portal. Monitors all network provider file loads, addressing resulting errors timely and efficiently.
• In support of Medicare Advantage compliance, coordinate the excluded and precluded provider updates based on the Center for Medicare and Medicaid requirements.
• Orients, trains, and assists Dental Network Specialist(s), sharing tasks and responsibilities through cross-training to ensure seamless support and effective teamwork.
• Performs other duties as assigned.

Qualifications:

Superior Dental Care - Dental Network Specialist

• Associate degree in business or healthcare administration, communications or related field.
• Equivalent education and experience directly related to the role may substitute for a degree.
• 2 years of experience associated with provider network credentialling or equivalent customer service experience, preferably in dental insurance, dental providers office, or the healthcare/health insurance industry.
• Intermediate MS Office skills.
• Knowledge of provider contracts, network arrangements and fee schedule structures.
• Knowledge of standard customer service best practices and principles.
• Knowledge of Heath Insurance Portability and Accountability Act (HIPAA).

Superior Dental Care - Senior Dental Network Specialist

• Associate degree in business or healthcare administration, communications or related field.
• Equivalent education and experience directly related to the role may substitute for a degree.
• 3 years of experience associated with provider network credentialling or equivalent customer service experience, preferably in dental insurance, dental providers office, or the healthcare/health insurance industry.
• Intermediate MS Office skills.
• Strong knowledge of provider contracts, network arrangements and fee schedule structures.
• Strong knowledge of standard customer service best practices and principles.
• Knowledge of Heath Insurance Portability and Accountability Act (HIPAA).

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

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